I just recently finished reading an interesting essay on addictions by Dr Lloyd Sederer a psychiatrist at Columbia University. While I don’t agree with his recommendations, he does remind us of some seminal research from the 1970s that helps to explain the problem.

When I’ve written on this topic in the past, I always mention the large number of military personnel during the Viet Nam war who used substances. The US feared that many of them would continue when they returned to the US but most did not. Out of a war zone and back into leading a normal life, most had no need for substances. That was the topic of the research referred to as the “rat park”.

Rats who were caged were offered two types of drinks. One was pure water and the other was water laced with heroin or cocaine. The rats took the drug laced drink and continued to drink from it until they overdosed and died.

A second group of rats were put into social situations called rat parks. Here, they were able to play and cavort with their buddies, hold discussions and debates, have sex and generally enjoy themselves. While they occasionally tried the drug infused water, they mostly drank the pure water and did not overdose. The moral, of course, is that rats/people with meaningful activities in their lives tend to stay away from addicting behaviour.

Dr Sederer sees the solution to dealing with and treating those with addictions as having clinicians “focus on their families, their social communities, their sources of human contact and support”. Now Dr Sederer admits that he is not naive about human behaviour but he adds that “these questions open essential doors.”

The problem with his view is that it is over simplistic. He is correct that social situations are often precursors to addicting behaviour but those conditions cannot be alleviated entirely in the treating docs office. The problems are often societal and caused in large part by lack of meaningful work, low income, and the lack of societal safety nets. Work is disappearing to a large extent for those with minimal skills who used to be employed in factories, mines, and retail stores.

According to the Atlantic, The disappearance of manufacturing and the rise of opioid abuse has hit men in the Rust Belt hard. For many, the lack of work and low income with minimal social safety nets has lead to escape through drugs. And with increasing automation and artificial intelligence, more jobs will disappear in the future. We will be left with a society where the work force will continue to shrink resulting in even greater poverty.

Economists have suggested that there is a link between opioid addiction and unemployment. A more recent study by Vancouver Coastal Health demonstrated that The primary cause of the opioid crisis is a “complex interaction” of socioeconomic problems, such as unemployment and homelessness, combined with substance abuse and an increasingly dangerous black market supply.

Ten years ago, the Hamilton Spectator did an analysis of health conditions in that city and found that those who live in the poorest areas have the worst health and utilize health care more extensively. That paper just updated the study looking at opioid overdoses and deaths. What it found was that opioid addiction was far more prevalent in the poor sections of the city.

“This is about despair,” said Neil Johnston, a McMaster University researcher who was involved in the original study. He added

“It’s about despair, whether you’re hooked on something nasty and you feel you can’t get out or nobody cares whether you get out. One way or another it’s a terribly malignant force.”

The only viable solution, in my opinion, is a guaranteed annual income for those who are unemployable or whose incomes through work are very low. And this should be combined with making drugs available to those who are addicted. Portugal has demonstrated that the social and societal benefits of this policy are enormous.

Another group with addiction problems that I’ve just realized are those with serious mental illnesses. Again, a very complex issue but what I’m now noticing is that when the mental health system stabilizes people, they pay little or no attention to their other needs for meaningful activity or income. The system rarely provides any activities for them where they can be actively engaged,, possibly earn some extra money, make friends and have satisfying social activities. Drugs are a way of making themselves feel better when nothing else does.

Social workers can and do play a significant role in helping the mentally ill to recover when they work with psychiatrists, nurses and occupational therapists. In my personal life, I’ve just witnessed how a knowledgeable and caring social worker can impact recovery from psychosis in an inpatient setting.

Sadly, the training that many social work students (and others like psychologists and counsellors) receive from some institutions does not aid in that role. Susan Inman, the author ofAfter Her Brain Broke, Helping My Daughter Recover Her Sanity, has long complained about the lack of science and medical training for many of these professionals. She said:

“Many credentialed mental health clinicians have never received science-based curriculum on severe mental illnesses. Too many are still being trained in the parent blaming theories which contemporary psychiatric approaches to schizophrenia have long since left behind.”

For a number of reasons, I had occasion to look at the mental illness course being taught at McMaster University in Hamilton Ontario and it confirms all that Susan had to say. The course is called “Critical Issues in Mental Health & Addiction: Mad & Critical Disability Studies Perspectives for SW”. Part of the course objective is to:

“explore contributions from critical disability studies, mad studies and the historical influences of sanism and eugenics on contemporary mental health practice. Addiction will also be briefly explored within these contexts.”

Then, this is added

“Throughout the course guest speakers may be invited to share experiences and analyses on course themes from ex-patient, survivor, consumer, service-user, and mad perspectives.”

Nowhere do I see anyone coming who can provide the medical perspective which would include the physiology and treatment of mental illness. Given that McMaster has a world-class medical school and one if its teaching hospitals is a psychiatric facility, this is very troubling. It would be so easy to find a psychiatrist to talk to the class or to take a field trip to the local psychiatric hospital.

One of the readings in the first week is “Geppert, C. (2004). The Anti-Psychiatry Movement Is Alive and Well. Psychiatric Times 21(3), 21. Retrieved December 4, 2009”. This article is no longer on the Psychiatric Times website that I could find and the professor referenced it in 2009. It would be nice if the professor asked his students to read something like Psychiatry and Anti-Psychiatry by Dr Allen Frances. There are many comparisons of these two approaches in that article and students should have an opportunity to see both sides.

Another set of readings for this course is by Geoffrey Reaume who is a professor of disability studies at York University in Toronto. His view of Mad Studies can be summed up by a quote he gave to an article on Mad Studies in University Affairs in 2015. He stated that “People with PhDs had oppressed mad people throughout history. I wanted to help liberate this history from the shackles of the medical model.”

Dr Frances had this to say in the article I cited above (for psychologist also read social worker):

“Psychiatry is far from perfect, but it remains the most patient-centered and humanistic of all medical specialties and has the lowest rate of malpractice among all specialties.

Psychologists criticize psychiatry for its reliance on a medical model, its terminology, its bio-reductionism, and its excessive use of medication. All of these are legitimate concerns, but psychologists often go equally overboard in the exact opposite direction—espousing an extreme psychosocial reductionism that denies any biological causation or any role for medication, even in the treatment of people with severe mental illness. Psychologists tend to treat milder problems, for which a narrow psychosocial approach makes perfect sense and meds are unnecessary. Their error is to generalize from their experience with the almost well to the needs of the really sick.”

And he added:

“For people with severe mental illness (eg, chronic schizophrenia or bipolar disorder), a broad biopsychosocial model is necessary to understand etiology—and medication is usually necessary as part of treatment. Biological reductionism and psychosocial reductionism are at perpetual war with one another and also with simple common sense.”

Another author used quite a bit in this course is Bonnie Burstow of the Ontario Institute for Studies in Education (OISE) at the University of Toronto. Dr Burstow is the creator of a scholarship in Anti-Psychiatry Studies. I’ve done two Huffington Post blogs about Dr Burstow. The first was entitled The Truth Behind U Of T’s Anti-Psychiatry Scholarship and the second was Time For U Of T To Rein In Its Anti-Psychiatry Activist It is worth noting that OISE is a post graduate school on teaching, learning and research. Nothing to do with science or medicine.

In my second Huffington Post blog, I had this to say about Dr Burstow:

Burstow does not believe that the brain is capable of becoming ill, and that therefore mental illness cannot exist. Her doctoral thesis, according to the media spokesperson at her institution, was entitled “Authentic Human Existence: Its Nature, Its Opposite, Its Meaning for Therapy: A Rendering of and a Response to the Position of Jean-Paul Sartre” in 1982 at the University of Toronto.

Dr Burstow is the author of a book called Psychiatry and the Business of Madness which is not one of the readings for this course but exemplifies her position. Blogger, Mark Roseman wrote a very lengthy and detailed critique of this book which is well worth reading.

Roseman defines anti-psychiatry as:

a position that psychiatry is 100% flawed, has no redeeming features, is built on a stack of lies, necessarily does harm to all who encounter it, and must be abolished in its entirety. Moreover, the real proponents of antipsychiatry do not want to seriously engage in discussion with the broader community. They are not interested in critique, or divergent opinions, but only discouraging those seeking treatment, and attracting new followers to their movement.

The course does discuss medication but this is the description of that:

“The Biological Mind: What are some of the critiques of the role of medication and the psychopharmaceutical industrial complex? How does neoliberalism matter in mental health? How do we think critically about suicide and self-harm?”

The titles give it all away. Whitaker, of course is an infamous anti-medication proponent and I have critiqued his views a number of times as have others more qualified that I am as in the debate between Whitaker and Dr Allen. The teaching of anti-psychiatry did not include anything pro-psychiatry and the discussion of medication contained no information on the benefits of medication. Should students not be given an opportunity to see the other side? McMaster and its teaching hospital has many first rate psychiatrists well versed in their specialties. I’ve observed the near miraculous results that properly prescribed medications can have on severe psychosis. Neoliberalism did not come up once.

The bottom line is that no one who graduates from this course will be capable of working in a psychiatric setting with patients. Hopefully, none of them will. The effective social worker I cited at the outset is a graduate of another university.

For those of you not familiar with Mad in America (MIA), it is a US organization begun by journalist Robert Whitaker. He is the author of books that are highly critical of modern psychiatry and its reliance on medication particularly for schizophrenia. As they say on their website they “investigate the problems and deficiencies with the current drug-based paradigm of care.”

I happened to come across this announcement on their site: “In World Psychiatry, two Canadian psychiatrists argue that the body of scientific evidence about schizophrenia shows that it is not a progressive illness and therefore we should have much higher expectations of full recoveries than we do.” I was intrigued because one of the authors of this study is Dr Robert Zipurski of McMaster University in Hamilton, Ontario.

Once before, MIA cited a study by him that used quotes selectively. They implied that Dr Zipurski provided proof of the evils of antipsychotic medication. Their website stated “decreases in brain tissue volumes are attributable to antipsychotic medication, substance abuse, and other secondary factors.” But, a careful reading of that paper found that when people discontinue medication early, the relapse rate is up to 78 per cent compared to 0-12 per cent for those who remain on medication.

MIA did not provide its own interpretation of this current paper which Dr Zipurski wrote with Dr Ofer Agid of the Centre for Addiction and Mental Health in Toronto. The two authors continue from the previous paper mentioned above and point out that:

Relapse of psychotic symptoms following a remission from a first episode of schizophrenia is also observed to occur in over 80% of individuals when studied naturalistically. This is largely attributable to discontinuation of antipsychotic medication rather than to the effects of an unrelenting disease process. The risk of symptom recurrence in remitted first episode patients receiving maintenance antipsychotic treatment is estimated to be in the range 0-5% in the first year of follow-up, compared to 78% in the first year off medication and close to 100% after three years off medication.

The authors then go on to wonder why outcomes are so poor if people have the ability to remain in remission. The reasons, they say, are numerous including the lack of services for these people or that they refuse treatment. Then, of those who are treated, about 20-30% are treatment resistant to the available antipsychotic medications. Others are non compliant with medication and so have relapses and re-hospitalizations. For others, their concurrent problems with alcohol, drugs, and other mental illnesses mitigate against retained recovery.

They conclude that while “there is room for debate about how recovery should be defined, it should be clear that most individuals with schizophrenia have the potential to achieve a stable remission of symptoms and substantial levels of satisfaction and happiness.”

That stability, they say, can be achieved with antipsychotic medication. Physicians/scientists/psychiatrists who observed that this dementia praecox or group of schizophrenias appeared to be a progressive disease were observing people with this illness pre 1960 before anti-psychotics were available – they were not wrong or overly pessimistic as there were no effective treatments at the time.

And it does take time for science to recognize that if someone begins antipsychotics at about age 19 and remains on them along with good medical care, that they can get to old age and remain stable or even improve.

It is encouraging to see MIA recognizing the importance of drug treatment by their promotion of this paper.

We can understand the difficulty, the sensitivities weighing on the judge’s mind when he made that decision. Memories of recent land disputes in Caledonia, the Oka stand off, mercury poisoning in Northern Ontario, a history of insensitive forced resettlement, and residential schools. We need to be sensitive and cautious and respectful.

And had this been the case of a family choosing a long established culturally relevant healing practice over an only partially effective Western Surgery, the decision would have made some sense. Even if it had been refusal of a transfusion that would have only improved chances by, say, 10 percent, the judge’s decision would be understandable.

But it wasn’t. It was the family choosing to pursue not a traditional native treatment as they claimed but a very modern European/North American flim flam to treat an illness that is fatal, rather than a scientifically proven treatment that is known to be 90 to 95% effective. And not just partially effective, but curative.

But rather than rant about the decision, and the “alternative treatments”, we should point out “our” failure. By “our” we mean the institutions of scientific, evidence-based modern western medicine. The competing systems here are, in one corner:

McMaster University Health Sciences Center. McMaster University Department of Pediatrics. McMaster University department of pediatric oncology. And all in association with researchers, clinicians, libraries, scholars, journals filled with scientific evidence around the world.

vs.

In the other corner, The Hippocrates Health Institute of West Palm Beach, a licensed massage institute and its director, a man who calls himself doctor who is not an MD, one Brian Clement. According to scienceblog.com, its programs are a cornucopia of nearly every quackery on the planet.

We looked at their website. The website is very slick, replete with testimonials and promises, and physically the place could pass for a resort in Tahiti. A smiling personnel awaits you. A store will sell you its products. The founder is one Ann Wigmore, a self-educated nutritionist with a fondness for raw foods. I have no doubt a week or two spent there would be, for those of us with a penchant for alcohol, barbecue, stress, and worry, a healthy experience.

But surely, with a little more tact, a little more patience, a better way of explaining, a more thoughtful and empathic approach, some honesty coated with hope, understanding of human fear and trepidation, an understanding of a parent’s pain while watching a child in pain…. Well, maybe they tried their best. But really, surely the McMaster University Health Sciences Center should be able to win the hearts and minds of its patients over the Hippocrates Health Massage parlour of West Palm Beach.

Addendum on Nutrition By Dr David Laing Dawson

My mother (and I’m sure your mother) used to regularly tell us kids to “Eat your carrots.” This included raw carrots of course, though mostly boiled. She might vaguely mention they were good for eyesight, for night vision. And fish every Friday was good for the brain. Some greens on the plate were important, a little fruit every day. Brown bread was better than white. Not too much fat. Not too much meat. Plenty of “ruffage” for the bowels. And chew carefully, eating slowly, while sitting at a table. Don’t skip breakfast.

If you need a snack between meals, eat an apple. Drink lots of water. And the only two supplements we received every morning were Vitamin D, and cod liver oil.

She was just my mother. I had no idea at the time that she was really a pioneer nutritionist. A pioneer in the field of alternative medicine circa 1950. Of course she didn’t know this either.

It is quite fascinating to learn that after another 64 years of scientific study, after countless reports and vastly increased knowledge of human physiology, there is little more to good nutrition than what my mother already knew. There have been many fads since. They come and go. But my mother’s ideas of good nutrition are the only ones that have withstood scientific study. So science supports my mother. And my mother knew, as does science, that though her nutritional advice was a good foundation for a healthy body and brain, it is not a cure for cancer.

Perhaps the even more fascinating thing is, that though science has so far proved my mother both correct and thorough in her advice, millions of people today follow wildly crazy nutritional patterns, usually propounded by other people set to make a profit on such behaviour, and more than a few are seduced into believing that my mother’s nutritional advice, coupled with my father’s advice to always look on the bright side and get a little exercise, cures cancer and numerous other diseases.